Download ACL Reconstruction: Preparing for Surgery

FACT SHEET FOR PATIENTS AND FAMILIES
ACL Reconstruction: Preparing for Surgery
What is ACL reconstruction?
This is a type of surgery to replace a ligament in the
center of your knee, which is called the ACL (anterior
cruciate ligament). A ligament is a strong band of
tissue that attaches one bone to another. The ACL is
1 of 4 ligaments that attach your thigh bone (femur)
to your shin bone (tibia). Your ACL keeps your shin
bone in place and your knee from buckling (“giving
out”) during physical activity. A damaged ACL will
not heal on its own.
An ACL tear is a common knee injury, especially
in people who do sports that involve running
combined with pivoting and jumping.
Why do I need it?
Your doctor may recommend ACL reconstruction if
you have:
•• A knee that gives out or feels unstable during
everyday activities
•• Ongoing knee pain or other injured ligaments
•• Gone through a rehabilitation program and still are
having symptoms
•• A job that requires knee strength or are very active
in sports
•• A willingness to complete a difficult rehabilitation
program
Femur
Tibia
The ACL is one of the 4 main ligaments that connect
the thigh bone (femur) to the shin bone (tibia).
The surgeon can graft a new ACL into the bones.
Where does a new ligament come from?
The tissue used to create your new ACL is called a
graft and can come from your body (an autograft) or
from a donor (an allograft). An autograft is most often
taken from the hamstring tendon or knee cap tendon.
The hamstring is the muscle at the back of your knee
and thigh. An allograft comes from someone who,
before death, chose to donate their body to help others.
What are the benefits and risks?
Talk with your doctor about benefits, risks, and
alternatives to ACL reconstruction (see below). Also
ask about the time and effort it will take to recover.
Potential benefits
Risks and potential complications
Alternatives
•• Increased stability
in the knee
•• Risks related to any surgery: Allergic
reaction to anesthesia, breathing
problems, bleeding, infection
ACL reconstruction is usually done
after non-surgical options have been
tried. These can include:
•• Risk related to ACL reconstruction:
Blood clot in the leg, ligament does not
heal, surgery does not relieve symptoms
•• Physical therapy and rehabilitation
exercises
•• Knee braces
•• Decreased pain
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How do I prepare for surgery?
What happens after surgery?
To make your surgery go better, try to:
After surgery, you will be taken to a recovery area where
nurses monitor your vital signs until the anesthesia
wears off. You can go home when your vital signs are
normal and you are fully awake — usually about 2
hours after surgery.
•• Stop smoking. Non-smokers have better outcomes
and recover faster.
•• Ask for time off work. Ask your doctor how long
you may need to be off work, and arrange this with
your employer.
•• Check your medicines. Ask your doctor if you
should stop taking any current medicines before
surgery. On the day of surgery, bring a list of all
medicines, vitamins, and supplements you take.
•• Fast the night before. Don’t eat or drink anything
for 8 to 12 hours before surgery. Take routine
medicines, if told to do so, with a few sips of water.
•• Arrange for someone to drive you home and
stay with you for the first 24 hours.
Your healthcare providers will talk with you about how
the surgery went and what you should do at home.
Since you may not remember all of this information,
ask a friend or family member to take notes.
What does rehabilitation involve?
is a series of exercises and treatments
designed to help you recover from surgery and
rebuild your strength. For most ACL reconstructions,
rehabilitation can take a few months and may involve:
Rehabilitation
•• Wearing a knee brace for a week or more
What happens during surgery?
•• Using crutches for several weeks
Before surgery, an anesthesiologist will talk with you
about pain control — either general anesthesia that
keeps you asleep and pain free or regional anesthesia
that blocks feeling in your legs. The surgery itself will
be done by an orthopedic surgeon and usually takes
between 60 and 90 minutes. It involves:
•• Doing physical therapy exercises for several months
•• Restricting some activity for several months
•• Taking pain medicine for a brief time
Athletes will need a doctor’s signed permission before
returning to competitive sports.
•• Making small incisions. For this type of surgery
(called arthroscopy), the surgeon typically makes
2 or 3 small incisions (cuts) around the knee and
inserts small instruments that will be used to make
repairs. Sterile fluid may also be added to expand
the area and make it easier to see and work on.
What can I expect?
•• Preparing for the graft. The surgeon removes
the damaged ACL. If you’re having an autograft,
there will be another incision for taking replacement tissue (graft) from another part of your leg.
For more information
•• Placing the graft. The surgeon drills small holes in
your thigh and shin bones where the graft will be
placed. As it heals, the holes in the bone fill in and
keep the new ligament in place.
About 90% of people who have ACL reconstruction
surgery have improved knee stability. How successful
your surgery is depends in large part on how carefully
you do your rehabilitation activities.
Ask your doctor for these Intermountain fact sheets:
FACT SHEET FOR PATIENTS AND FAMILIES
FACT SHEET FOR PATIENTS AND FAMILIES
ACL Reconstruction: Home Instructions
Allograft Transplant
Arthroscopic Knee Surgery
What happens after ACL
reconstruction surgery?
What is an allograft?
What is it?
After ACL reconstruction surgery, there’s a lot you can do
to make sure you have a good outcome. At first you can
help your wound heal by managing the pain and swelling.
You’ll also need to start right away with rehabilitation
exercises. These are exercises to help you regain range of
motion in your knee, and to restore your sense of balance
and control in your leg.
You may need to wear a
brace to keep your knee
stable while it heals.
Allografts are used in a variety of procedures that
can save lives, repair limbs, relieve pain, or improve
a patient’s quality of life.
• Bone, tendons and ligaments can be used in
orthopedics, neurosurgery, dental surgery and
plastic surgery.
How do I care for myself at home?
• Heart valves and blood vessels are used in
heart surgery.
In the first days after surgery, your leg will be swollen
and you will have a thick dressing covering your surgical
wounds. Below are a few tips that will help you care for
yourself and your incisions:
• Skin can be used to treat severe burns or used
in abdominal surgery.
Manage pain and swelling
Care for your incision
• Take pain medication as prescribed. When you leave
the hospital, your pain should be under good control.
Your doctor may give you a prescription for pain
medication to take at home. Take your pain medication
as soon as you need it. Don’t wait for the pain to get
too bad. Don’t take any pain medication that your
doctor has not prescribed. Don’t drink alcohol while
taking pain medication.
• Keep your dressings clean and dry. Your doctor
will let you know when you can remove your dressings
and when it’s okay to take a shower without worrying
about getting your incisions wet. Do not soak in a tub,
pool, or hot tub until your doctor says it’s okay.
• Elevate your leg. For the first two days, keep your
leg elevated above your heart. Lie flat and use pillows
to prop up your knee.
The Food and Drug
Administration (FDA) has
closely regulated the tissue
donation process since 1993.
The process is very safe.
In arthroscopic knee surgery, the surgeon inserts an
arthroscope (a tube with a tiny camera) into your knee
to explore and diagnose problems. The surgeon can then
insert small tools through tiny openings to repair or
remove damaged tissue.
• Corneas can restore vision to a person whose
cornea has been damaged or failed.
• Donated bone or tissue can also be used in
products that are used during surgery, such as
Demineralized Bone Matrix, a type of bone putty.
• Wear your compression stockings (T.E.D. hose) as
long as your doctor advises. Compression stockings
help prevent blood clots.
• Watch for bleeding. You may have a small amount of
bleeding from your surgical incisions. This is normal.
• Watch for signs of infection at the incision site
(increased redness or swelling, pus, or fever over 101° F)
and report them to your doctor.
Cartilage
Cartilage
membrane
Ligament
Ligament
Meniscus
Meniscus
Why do I need it?
Arthroscopic surgery might be recommended if your knee
continues to be painful, “catches” or gives way, or keeps
swelling. Knee problems diagnosed and treated with
arthroscopic surgery include:
Why do I need to use another
person’s tissue?
Sometimes, there’s not enough of your own tissue to
use in an operation. Synthetic (man-made) materials
have different properties from human tissue and may
not be right for some patients or purposes.
• Torn ligaments
• A damaged meniscus
• Scar tissue or joint infections
• Inflamed synovial membrane
• Unexplained knee pain that doesn’t respond
to other treatments
Potential benefits
Potential benefits
Risks and potential complications
Alternatives
• Accurate diagnosis. The arthroscopic
image helps your doctor get a better
picture of what’s wrong with your knee.
• The transplanted tissue can
repair or replace bones, tendons,
ligaments, heart valves, skin,
or corneas.
• Even with antibiotics and careful sterile techniques, in any
surgery there is a small risk of infection or reaction
to anesthesia.
• In a few cases it may be
possible to use your own
tissue from another part of
your body (autograft).
• Faster recovery than with traditional
surgery. Recovery is usually faster than
with surgery involving larger incisions.
• Tissue is not taken from another
part of your body, so there is no
additional wound to heal.
• Your doctor will discuss with you any risks for your specific
type of allograft.
• Infection from transplanted tissue is extremely rare.
• Less scarring. The incisions result in very
small scars which are not easily noticed
and don’t interfere with movement.
You may have arthroscopic knee surgery to
repair damage to these parts of your knee.
Talking with your doctor about
this procedure
• Damaged or torn cartilage
• Loose fragments of bone or cartilage
Talking with your doctor
Before you are scheduled for an allograft transplant,
you will meet with your doctor to discuss it. The table
below lists some potential benefits, risks and alternatives
for allograft transplant, but others will apply in your
unique situation. Talking with your doctor is the most
important part of learning about allograft transplant.
If you have questions, be sure to ask.
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ACL Reconstruction:
Home Instructions
Synovial
Synovial
fluid
fluid
Synovial
Synovial
membrane
In this type of surgery, problems are diagnosed and treated
without large incisions (cuts). This surgery usually does
not involve a hospital stay.
What are allografts used for?
For most patients, regaining full strength, balance, and
control in the knee and leg takes several months. How
fast and how well you recover depends in large part
on how consistently and carefully you do your
rehabilitation exercises.
• Use ice as directed by your doctor to relieve pain
and swelling. Your doctor may recommend a special
ice machine.
•• Closing the wound. The surgeon will close the
wound with sutures (stitches) or staples and cover it
with a dressing.
An allograft is tissue that is transplanted from one
person to another. The prefix allo comes from a
Greek word meaning “other.” (If tissue is moved
from one place to another in your own body, it is
called an autograft.) About 1,500,000 allografts
are transplanted each year.
Your surgeon replaced the
damaged ACL with a new
piece of tissue.
FACT SHEET FOR PATIENTS AND FAMILIES
Your doctor will talk with you about your surgery,
including the most common benefits, risks, and
alternatives for this procedure. Other benefits and risks
may apply in your unique medical situation. The
conversation you have with your doctor is the most
important part of learning about your surgery and what
to expect.
Potential risks and complications
Alternatives
• Bleeding or Infection. With any surgery,
there is a small risk of bleeding or developing
a wound infection. Antibiotics and careful
sterile techniques are used to prevent this.
• Medications
• Failure to relieve symptoms. Your
surgeon will do everything possible to give
you the best results. Even so, surgery may not
relieve all your symptoms.
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Allograft
Transplant
Arthroscopic knee surgery is usually
done after non-surgical options have
been tried. These can include:
• Knee wraps or other supports
• Physical therapy
• Decrease in activity
• Blood clots in the joint or bleeding
into the joint. These problems are rare
and treatable.
Arthroscopic
Knee Surgery
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should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is
available at intermountainhealthcare.org. Patient and Provider Publications FS274 - 09/16 (Last reviewed - 09/16) Also available in Spanish.
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